Omaha Merchant Processing Application, together with the Omaha Confirmation Page, is the most common application form submitted by the sales representatives. These two forms are required to submit an account to Fiserv. This article is created to assist you (Onboarding Associate) should a prefilled application is needed to be sent to the merchant for signing.
Note: Make sure you have the updated version of the application. As of writing this article, v2701 is the latest to have been released.
OMAHA MERCHANT PROCESSING APPLICATION
PAGE 1: BUSINESS INFORMATION
| Client's Business Name (DBA) | Referred to as “Doing Business As”. This is the name of the business that is visible to the customers (storefront, window, and/or door signages). |
| Business Address | Referred to as the “Location Address”. This is where the physical store of the business is situated. |
| City | Business city. |
| State | Business state. |
| Zip | Business zip. |
| Location Phone | Referred to as the “Business Phone”. This is commonly the phone number associated with the business. |
| Location Fax Number | Leave blank, unless otherwise, specified. |
| Business E-mail Address | Commonly the owner’s email address. This is where they will receive email notifications from Turnkey, the Platform they are boarded on, Clover updates, etc. |
| Business Website Address | Leave blank, unless otherwise, specified. *E-Commerce account and needs integration with website, this is required. |
| Date Business Started | Referred to as the “Open Date”. This can be cross-checked via the Secretary of State website. |
| Customer Service Phone Number | The same with "Location Phone". |
| Customer Service E-mail Address | Leave blank, unless otherwise, specified. |
| Client's Corporate/Legal Name | Referred to as the “IRS Name”. This is the name they file their taxes under, which can be completely different from the DBA. To verify, an EIN Letter may be requested or you can search it up to the Secretary of State. |
| Billing Address | If the merchant has a different billing address than their location address, specify. Otherwise, disregard. This might be their legal address. |
| City | If the merchant has a different billing address than their location address, specify. Otherwise, disregard. This might be their legal city. |
| State | If the merchant has a different billing address than their location address, specify. Otherwise, disregard. This might be their legal state. |
| Zip | If the merchant has a different billing address than their location address, specify. Otherwise, disregard. This might be their legal zip. |
| Contact Name | Usually the owner's name, unless otherwise, specified. |
| Contact Fax Number / E-mail Address | Leave blank, unless otherwise, specified. |
| Contact Phone Number | Contact name's personal phone number. |
| Send Retrieval Request | Default is business location, unless otherwise, the merchant requests to send requests to their legal address. |
| Sent Merchant Monthly Statement to | Default is business location, unless otherwise, the merchant requests to send statements to their legal address. |
| Legal Entity & State (Choose 1) |
Individual/Sole Proprietorship - legal name and owner's name are the same. Tax Exempt Organization - a 501C letter is required. Corporation - Corp, Corporation, Inc, Incorporated, Comp, Company. Limited Liability Company - PLLC, LLC. |
| Name (Legal Name) | Referred to as the “IRS Name”. This is the name they file their taxes under, which can be completely different from the DBA. To verify, an EIN Letter may be requested or you can search it up to the Secretary of State. |
| Federal Tax ID Number | Referred to as the “Employer Identification Number”. Each legal entity has a unique nine-digit identification number that they are also filing the taxes under. This can be verified via their EIN letter. For Sole Proprietorship, their EIN and SSN are the same. |
| Foreign Entity Certification | Disregard this section. |
| SIC/MCC | Refer to the type of business and locate the MCC using the MCC List Combined. |
| Type of Merchandise, Products or Services Sold | Based on what the business is selling, this can be classified accordingly. A quick google search will be able to assist on what type of business the account is. This is to help us identify what Merchant Category Code (MCC) to use for boarding. |
PAGE 1: ADDITIOANAL CREDIT / SITE SURVEY INFORMATION
This section is filled out by the sales rep. If not filled out, follow the default set-up once application is submitted. Don't forget to check the Merchant Initial on the lower right portion of the page.
PAGE 2: OWNER'S INFORMATION
Don't forget to fill out the DBA Name on the upper left portion of the page and check the Merchant Initial on the lower right portion of the page.
| CONTROLLING INDIVIDUAL & OWNER 1 - These sections are expected to have the same information. | |
| Name | Signer’s full name. The signer should have at least 25% ownership percentage. |
| Title | Signer’s designation in the business. This is commonly the owner, but can sometimes be the manager. |
| Ownership % | Signer’s ownership percentage. |
| Date of Birth | Signer’s date of birth matching his/her legal documentation. |
| Social Security Number | Referred to as the “Social Security Number”. This is a nine-digit number issued to U.S. citizens, permanent residents, and temporary residents. Signers with SSN starting with a 9 are referred to as an ITIN merchant, which requires additional information. |
| Home Address | Signer’s home address matching his/her Driver’s License or any legal documentation. Should be within the United States. |
| Home Phone | Personal phone number of the signer. This can be the same with the business phone, but advisable to be different. |
| City | Signer's home city. |
| State | Signer's home state. |
| Zip | Signer's home zip. |
| Country | Unnecessary. |
If there are other owners, fill out their information under Owner 2, 3, and 4.
PAGE 2: SETTLEMENT INFORMATION
| Deposit Bank | Name of bank on the bank documentation. |
| Transit / ABA Number | 9-Digit Number, to verify, search in via google search to verify bank name. |
| Deposit Account Number | Account number. |
| ACH Detail Flag | Usually combined but disregard this section if not explicitly requested by the merchant. |
PAGE 2: TRANSACTION INFORMATION
| Gross Yearly Sales Volume | Rough estimate of their annual credit card volume plus cash sales. |
| Average Yearly Mastercard/Vias Volume | If not specified, calculate 70% of the annual credit card volume's rough estimate. Exclude cash sales. |
| Average Yearly Discover Network-PayPal Volume | If not specified, calculate 10% of the annual credit card volume's rough estimate. Exclude cash sales. |
| Average Yearly American Express OptBlue Volume | If not specified, calculate 20% of the annual credit card volume's rough estimate. Exclude cash sales. Should not be more than $1,000,000. |
| Seasonal | If season, indicate months when the business is open. |
| Average MC/V/D-PayPal Ticket | Rough estimate of their average credit card ticket. |
| Average Amex OptBlue Ticket | Rough estimate of their average credit card ticket. |
| Highest Ticket |
Rough estimate of their highest ticket. If this is too high, merchant can get flagged and statements may be requested. If this is too low, transactions can be pulled and held by risk for review and the merchant may need to provide documentation. |
| Where is sale transacted? |
Typically 90% store front and 10% telephone order, unless otherwise, specified for MOTO accounts. Smoke or tobacco shops are always 100% store front. |
PAGE 2: GRID INFORMATION & SERVICE FEE SCHEDULE
You can disregard this section.
PAGE 3: SERVICE FEE SCHEDULE
Don't forget to fill out the DBA Name on the upper left portion of the page and check the Merchant Initial on the lower right portion of the page.
For this section, fill out the form based on pricing:
If the merchant is under Interchange Plus Pricing, fill out Pass Through Interchange items.
- Mastercard Qual Credit
- Mastercard Qual Debit
- Visa Qual Credit
- Visa Qual Debit
- Discover Network PayPal Qual Credit
- Discover Network Qual Debit
- American Express OptBlue Qual Credit
If the merchant is under Flat Rate or Cash Discount Pricing, fill out Flat Rate items. Only fill out "Discount Fee", disregard both MPG Rate and MPG Per Item.
- Mastercard Qualified Credit
- Mastercard Qualified Debit
- Visa Qualified Credit
- Visa Qualified Debit
- Discover Network - PayPal Qualified Credit
- Discover Network - PayPal Qualified Debit
- American Express OptBlue Qualified Credit
If the merchant is going to accept Pin Debit, check off "Pass Through Debit Network Fees" and indicate Other item Rate and/or Other Volume Percent.
Under Miscellaneous Fees, take note of the following fees:
| Dues and Assessments | If the merchant is under Interchange Plus Pricing, check off the box. |
| V/Mastercard Chargeback Fee | $15.00, regardless if indicated or not by the sales rep or merchant. |
| V/Mastercard Retrieval Fee | $15.00, regardless if indicated or not by the sales rep or merchant. |
| EBT Food Stamps & Cash Benefits | If the merchant accepts EBT, indicate the per item fee and FNS number. |
| Minimum Monthly Fee | $25.00, unless otherwise, the sales rep wants to opt it out. |
| ACH Reject Fee | $55.00, regardless if indicated or not by the sales rep or merchant. |
PAGE 4: SERVICE FEE SCHEDULE
Don't forget to fill out the DBA Name on the upper left portion of the page and check the Merchant Initial on the lower right portion of the page.
For this section, fill out the form based on pricing:
If the merchant is under Interchange Plus Pricing, fill out Authorization & Capture Transaction Fees.
- Mastercard/Visa Auth & Capture Fee
- Discover Network PayPal Auth & Capture Fee
- American Express OptBlue Auth & Capture Fee
If the merchant has a Monthly Fee, regardless of pricing, fill out Customer Service Fee under User Define Grid Fees.
PAGES 5-7: SERVICE FEE SCHEDULE
Don't forget to fill out the DBA Name on the upper left portion of the page and check the Merchant Initial on the lower right portion of the page.
PAGES 8: SIGNATURE
| CLIENT'S AUTHORIZED SIGNER | |
| Signature | Owner/Authorized Signer's signature. |
| Print Name of Signer |
Owner/Authorized Signer's full name. |
| Title | Owner/Authorized Signer's official designation. |
| Date | Date the document is signed. |
| PERSONAL GUARANTEE | |
| Signature | Not necessarily the owner, but defaulted to be the owner/authorized signer. |
| Print Name | Not necessarily the owner, but defaulted to be the owner/authorized signer. |
| Date | Date the document is signed. |
OMAHA CONFIRMATION PAGE
| Print Client's Business Legal Name | Referred to as the “IRS Name”. This is the name they file their taxes under, which can be completely different from the DBA. To verify, an EIN Letter may be requested or you can search it up to the Secretary of State. |
| Signature | Owner/Authorized Signer's signature. |
| Title | Owner/Authorized Signer's official designation. |
| Date |
Date the document is signed. |
| Print Name of Signer |
Owner/Authorized Signer's full name. |